Dance2advance registration form

Registration Form
Name as you wish it to appear on certificates

First Name Middle Name/Initial Last Name
Date of Birth

Month Day Year
Date
Phone Number

Area Code Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

City County

Post Code
Emergency contact

First Name Last Name
Phone Number

Area Code Phone Number
ISTD Pin Number
ISTD Membership Number (if known)
Dance School/College history
Genres Required

Classical Greek Imperial Ballet Modern Theatre Tap Dance
Highest level of qualification in each genre. Please state awarding body (ISTD, RAD etc) and result
Details of any other dance qualifications, diplomas, degrees etc
Please provide a short personal statement telling us about yourself and why you wish to train to be a dance teacher
Any injuries, allergies or medical conditions we need to be aware of

Filming and taping take place regularly at Dance2advance.

I agree to being photographed /filmed and for this to be published on the Dance2advance facebook page, website or in any media publications for promotional or marketing purposes.
YES NO
I have read the Dance2advance Privacy Policy and agree to my personal data being collected and securely stored.
YES NO
We may wish to contact you in future with details of courses/workshops we provide. If you consent to this, please tick to say how you would like us to contact you:
EMAIL PHONE PRIVATE MESSAGING

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Registration Form